Provider Demographics
NPI:1508474875
Name:JOHNSON, THOMAS GLENN (LMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GLENN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:GLENN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3243 HARPETH SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2385
Mailing Address - Country:US
Mailing Address - Phone:229-449-0920
Mailing Address - Fax:
Practice Address - Street 1:1949 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4015
Practice Address - Country:US
Practice Address - Phone:229-449-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1643106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist